1811181027 NPI number — MSPF II CROWLEY OE, L.P.

Table of content: (NPI 1811181027)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1811181027 NPI number — MSPF II CROWLEY OE, L.P.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MSPF II CROWLEY OE, L.P.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
CROWLEY NURSING AND REHABILITATION CENTER
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1811181027
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/14/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3811 TURTLE CREEK BLVD
Provider Second Line Business Mailing Address:
SUITE 1850
Provider Business Mailing Address City Name:
DALLAS
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75219-4489
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
214-651-4050
Provider Business Mailing Address Fax Number:
214-651-4001

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
920 E FM 1187
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CROWLEY
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
76036-4349
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
817-297-5600
Provider Business Practice Location Address Fax Number:
817-297-9613
Provider Enumeration Date:
08/30/2007

Additional Information

Authorized Official

Authorized Official Last Name:
RONCK
Authorized Official First Name:
DAVID
Authorized Official Middle Name:
Authorized Official Title or Position:
MANAGER
Authorized Official Telephone Number:
214-651-4050

Provider Taxonomy Codes

  • Taxonomy code: 314000000X , with the licence number:  122416 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1015354 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 103223 . This is a "DADS FACILITY ID" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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